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Video Details
Estética y predictibilidad en un diente anterior

Description:
En este video el Dr. Marcelo Ferrer nos muestra una técnica de expansión atraumática en un reborde alveolar atrófico. Para esto ejecuta una intervención de tejidos duros y blandos. Se presenta como una solución simple y predecible para casos cotidianos de la práctica clinica.

Date Added:
6/4/2012

Author(s):

Marcelo Ferrer Balart, DMD, MS Marcelo Ferrer Balart, DMD, MS
Dr. Marcelo Ferrer completed his undergraduate studies at the University of Chile in 2000, where he received his degree in Dentistry and the title of dental surgeon. He...
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Online Videos / Surgery / Implant / Estética y predictibilidad en un diente anterior




Questions & Comments
Dr. Evelyn Aldama-Espinosa - (9/10/2016 1:50 PM)

Profe, You are the best. Very Interesting course !!!

MARCELO FERRER - (6/10/2012 11:15 PM)

Estimado Miguel, muchas gracias por tus preguntas El conformador de hilo cumple dos propósitos en este caso, por un lado, ensanchar desde 3,2 a 3,75, medida que es inferior a los 3,8 mm de diametro del implante que se colocó, en ningun punto se disminuyo la estabilidad inicial del implante, si hubiese colocado el osteotomo mas ancho la historia podría haber sido diferente, el segundo proposito que encontré para hacerlo fue que el hecho de darle hilo hace que el implante no sea tan agresivo sobre todo con la tabla vestibular al autoroscarse en ella.... Con respecto a tu segunda pregunta te cuento que esta paciente tiene una sonrisa gingival bastante importante por lo que llevar el implante a donde se puso fue el mejor negocio que la biología del caso nos entrega como herramienta a nuestro favor. Al hacer manejo del tejido duro en la zona y colocar el implante en la zona y dejarlo sumergido nos entrega la posibilidad de hacer un segundo acto quirúrgico para evaluar acciones a realizar. No debemos temer a la fase de conexión del implante, al contrario debemos pensar que es un excelente momento para progresar en el caso buscando nuevas herramientas según sean necesarias para mejorar las condiciones locales de nuestras futuras rehabilitaciones. Por otro lado el hecho de solucionar en sentido horizontal el ancho del hueso no asegura que se remodele, sobretodo si tomas en cuenta q es un biotipo fino por lo tanto si tienes la oprtunidad de ensanchar o mejorar los tejidos tomala, siempre un milagro a la vez, en el segundo acto quirurgico encontraras una nueva oportinidad para ensanchar los tejidos como lo estimes conveniente Mucha suerte y cualquier duda feliz que la discutamos.

MARCELO FERRER - (6/10/2012 10:51 PM)

Estimado Alejandro, Gracias por tu consulta, los casos que realizamos siempre cuentan con estudio de modelos y encerados diagnósticos cuando se requiere y concuerdo contigo creo que es fundamental en nuestras practicas cotidianas. En este caso en particular la paciente venia con la idea clara de solo colocarse un implante y su corona en el mismo dia como alguien le habia informado. Con el estudio que se le realizo ella pudo darse cuenta que su problema era bastante mayor que solo su motivo de consulta. Se decidió en base a un estudio realizar algo con ese reborde atrofiado y fue en el mismo acto quirúrgico que en vez de manejar solo el reborde se decidió a colocar el implante al ver que afortunadamente para los planes futuros había una gran perdida de inserción en las piezas vecinas al espacio desdentado por lo que se decidió esperar y realizar los provisorios en la fase de conexión para evaluar la necesidad real de un ancho biológico en las piezas anterosuperiores. El propósito de este caso era mostrar no la planificación completa del caso sino una herramienta más o una técnica sencilla de ensanchar un reborde sin ser muy traumático con el poco remanente óseo que quedaba en la zona y como mejorar aun mas su predictibilidad al usar elementos biológicos que nos den mejores tejidos a la hora de enfrentar la zona estética en un segundo tiempo con la prototipización anterior completa.

Alejandro Lanis - (6/7/2012 10:58 PM)

Dr. Ferrer, muchas gracias por la presentación... De todas maneras es un caso complejo y de alta demanda estética en donde la posición implantaria se torna sumamente importante. Debido a que no se utilizará ortodoncia y a que los espacios y referencias dentarias serán modificadas por la futura rehabilitación en base a coronas, consideraría una opción haber realizado primero las preparaciones biológicas y ocupado los provisionales confeccionados en base a un encerado diagnóstico como guía quirúrgica para la colocación del implante? Saludos y felicitaciones

Miguel Hernandez374 - (6/7/2012 10:25 PM)

Dr Ferrer, felicitaciones. Dos consultas, ¿Por qué usar el conformador de hilo al final de la compactación ósea con los osteótomos? normalmente el hueso del maxilar sup.no ofrece mayor problema a la inserción de implantes, menos con el diseño del tapered internal. Con esa maniobra, incluso, se pudo haber perdido hueso (especialmente en vestibular)y haber disminuido la estabilidad inicial del implante. ¿por qué no usar un tej conectivo o alloderm en la zona supracrestal del defecto de los tejidos blandos que era la zona de mayor necesidad de engrosar en sentido vertical? (dado que la deficiencia horizontal había sido solucionada con el relleno óseo).De nuevo, felicitaciones por el resultado.

Miguel Hernandez374 - (6/7/2012 10:25 PM)

Dr Ferrer, felicitaciones. Dos consultas, ¿Por qué usar el conformador de hilo al final de la compactación ósea con los osteótomos? normalmente el hueso del maxilar sup.no ofrece mayor problema a la inserción de implantes, menos con el diseño del tapered internal. Con esa maniobra, incluso, se pudo haber perdido hueso (especialmente en vestibular)y haber disminuido la estabilidad inicial del implante. ¿por qué no usar un tej conectivo o alloderm en la zona supracrestal del defecto de los tejidos blandos que era la zona de mayor necesidad de engrosar en sentido vertical? (dado que la deficiencia horizontal había sido solucionada con el relleno óseo).De nuevo, felicitaciones por el resultado.

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